Intensivierte präoperative Eigenblutspende bei einem Patienten mit mehreren erythrozytären Alloantikörpern und schwerer Hämophilie A

We report the case of a 53-year-old patient suffering from severe hemophilia A showing six different blood group antibodies (anti-c, -Cw, -Jkb, -E, -Lea -Kpa). The decision to replace his left kneeendoprosthesis was made in September 1993. Having multiple erythrocyte antibodies he cannot be transfused with allogenic blood; on the other hand, a large intraoperative blood loss could be expected due to severe hemophilia. An intensified regimen for preoperative autologous blood donation including oral and intravenous iron supplementation, application of recombinant human erythropoietin, and cryopreservation of packed red cells was performed. The patient reached a predeposit of 23 units of autologous packed red cells and 20 units of autologous fresh frozen plasma. Surgery took place in February 1994. Estimated peri-operative blood loss was about 11 liters; the patient received autologous blood exclusively: 13 units of packed red cells and 20 units of fresh frozen plasma. Acute intraoperative hemodilution was performed yielding 2×500 ml of autologous blood; 2,200 ml of autologous packed red cells could be retransfused after intraoperative salvage. This case report shows the enormous possibilities of an intensified regimen in autologous blood donation using recombinant erythropoietin and intravenous iron supplementation.